Current status of surgical treatment of colorectal liver metastases

Liver metastasis(LM) is one of the major causes of death in patients with colorectal cancer(CRC). Approxi-mately 60% of CRC patients develop LM during the course of their illness. About 85% of these patients have unresectable disease at the time of presenta-tion. Surgical resection is currently the only curative treatment for patients with colorectal LM(CRLM). In recent years, with the help of modern multimodality therapy including systemic chemotherapy, radiation therapy, and surgery, the outcomes of CRLM treatment have significantly improved. This article summarizes the current status of surgical treatment of CRLM including evaluation of resectability, treatment for resectable LM, conversion therapy and liver transplantation for unresectable cases, liver resection for recurrent CRLM and elderly patients, and surgery for concomitant hepatic and extra-hepatic metastatic disease(EHMD). We believe that with the help of modern multimodality therapy, an aggressive oncosurgical approach should be implemented as it has the possibility of achieving a cure, even when EHMD is present in patients with CRLM.

Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus

Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40–70% patients eventually suffer from postoperative recurrence within 5 years. HCC recurrence after surgery severely affects prognosis of the patients. Nevertheless, there is an opportunity to improve patients' prognosis if doctors and researchers can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Hence, based on our own experience and published studies from other researchers, we develop this consensus regarding multidisciplinary management of locally recurrent and metastatic hepatocellular carcinoma after resection. This consensus consists of the entire course of recurrent hepatocellular carcinoma (RHCC) management, including prediction of recurrence, prevention, diagnosis, treatment and surveillance of RHCC. Consensus recommendations are presented with grades of evidences (Ia, Ib, IIa, IIb, III and IV), and strength ofrecommendations (A, B, C, D and E). We also develop a decision-making path for RHCC treatment, which can intuitively demonstrate the management for RHCC. It is hoped that we may make some effort to standardize the management of RHCC and ultimately understand how to improve outcomes.

Chills and fever as the first presentation of hepatic perivascular epithelioid cell tumor

A 70-year-old female was admitted to the hospital with a history of chills and fever (with a high temperature of 37.5 ℃) for 17 days. No obvious anomalies were detected on physical examination. Laboratory tests indicated white blood cells (6.96×109/L), neutrophil percentage (65%), C-reactive protein, and procalcitonin (0.766 ng/mL) in the normal range. The tests for liver function were normal, with Child-Pugh grade A, and the patient tested negative for hepatitis B virus infection.

A giant primary hepatic low-grade malignant mesenchymal tumor of the liver in a teenager

A 14-year-old girl presented with right upper abdominal swelling for two months.Physical examination revealed palpable hepatomegaly.Her laboratory analysis revealed a mild anemia(HGB:108 g/L).The tests for liver function were normal.The Child-Pugh score was A grade.The tests for hepatitis B and C viruses were negative.The tests for tumor markers such as carcinoembryonic antigen(CEA),α-fetoprotein(AFP),and cancer antigen 19-9(CA19-9)were normal.All other laboratory results were within the normal range.Abdominal ultrasound revealed an oval isoechoic mass in the liver measuring 26.4 cm×25.6 cm×12.6 cm,which was solid,ill-defined and had rich blood flow signals.Contrast-enhanced CT and MRI of the liver demonstrated a huge hepatic mass of 14.4 cm×21.5 cm×22.2 cm,and heterogenous enhancement with central necrosis,which involved all three hepatic veins,the left portal vein and had loss of fat planes with the inferior vena cava(Figure 1A,B).Three-dimensional reconstruction technology revealed that the total hepatic volume was 6,158.3 mL,and the tumor volume was 4,258.68 mL.Furthermore,the standard hepatic volume was 1,105 mL,the remnant liver volume was 1,373 mL(72%),and the indocyanine green clearance test at 15 minutes was 1.2%.

Chinese expert consensus on conversion therapy for hepatocellular carcinoma(2021 edition)

Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.

Pure fetal hepatoblastoma in a young female

A 22-year-old woman noted a fist-sized mass on her upper abdomen 1 month previously.She had occasional fever.Abdominal computed tomography(CT)and magnetic resonance imaging(MRI)revealed a huge lesion in the left lobe and intrahepatic metastasis(Panels A,B).